[jhdevos]

True - which is why they did the cream as well. At the very least, this study tells us that the mindfulness meditation is a 'more effective' placebo than the cream.

It's very hard do really do in a 'double blind' way - I would not be able to think of something that is to all appearances equal to the real mindfulness mediation, but actually only a fake. There's no substance to it.

Do you have any suggestions to do it better?

[lisper]

Use an activity-based sham therapy as the control, and have it administered by someone who believes it works. Waving magnets over the subject's body, for example.

[orblivion]

> At the very least, this study tells us that the mindfulness meditation is a 'more effective' placebo than the cream.

Which leads one to consider - what is a placebo anyway? It's a mental state one puts oneself in that improves physically measurable symptoms. That seems indistinguishable to me from meditation. If you think about it, it's kind of funny that skeptics like to dismiss impressive sounding treatments as being placebos. A placebo is a pretty impressive phenomenon!

If one can reliably create a reliable, powerful treatment that actually works (fixes what you're targeting rather rather than symptoms, unless symptoms are what you're targeting as in this case) by putting ones self into a mental state, that sounds like a win, even if it does meet the definition of a placebo.

[contravariant]

I always did wonder about that. Current research implies that placebos work as long as you believe they will work, even if you know they are a placebo. But then why would you need the placebo in the first place?

There seems to be no need to do anything really, if you can just stop thinking you're feeling bad then you'll actually feel better.

In principle there's no need for any specific instructions on meditation either, but it does seem to be related to meditation where you also aim to stop thinking about certain things, so those instructions are likely to be useful, even if they only turn out to be yet another placebo. After you gain more confidence that you can do it, you should have less need for those instructions though.

[DanBC]

> Current research implies that placebos work as long as you believe they will work, even if you know they are a placebo.

It depends on the research. There's some that don't find a strong placebo response.

[dTal]

>it's kind of funny that skeptics like to dismiss impressive sounding treatments as being placebos. A placebo is a pretty impressive phenomenon!

It's not about whether a treatment works at all - it's about whether it works better than any old random thing. If it doesn't, you can hardly call it a treatment. Sure you could go "hallelujah, a new medicine!" when you find that a sugar pill provides a slight improvement, just like sand pills and empty pills and homeopathy. But you haven't actually discovered anything new.

[orblivion]

> But you haven't actually discovered anything new.

The fact that sugar pills work may not be new, but it's still pretty remarkable.

[dTal]

It may be remarkable. But it is not a property of the sugar pills.

[austinjp]

This is why trials designs other than RCT can be appropriate. For example, one group could be randomised to receive meditation therapy now, and another group would receive it later. Ethically this is more comfortable too, since neither group is denied a potentially effective treatment.

I wonder if there is a well tested, robust placebo for meditation. Time to trawl the literature for protocols and designs.

[jamesk_au]

Those behind the study appear to be of the view that it can't be done:

"This study could not be designed in a double-blind fashion due to the nature of meditation training and placebo conditioning. Specifically, placebo cream could not be applied to all groups because this manipulation could potentially elicit analgesia even though the subjects were informed that the cream was inert (Kaptchuk et al., 2010). Furthermore, whereas subjects in the placebo-induced analgesia and book-listening control groups were clearly aware of their group assignment, subjects in the mindfulness and sham-mindfulness groups were blinded to their intervention assignment. For the mindfulness and sham-mindfulness groups, responses related to psychosocial influences (i.e., demand characteristics) presumably were minimal given that no significant differences in “perceived meditative effectiveness” were observed (p = 0.88; Table 2)."

[nroets]

Some meditation teachers concentrate on Buddhist teachings that's not part of mindfullness. They believe those teachings to be more important than mindfullness. If the experimentors ask one of those teachers to teach the patients to meditate, the meditation will be "fake".

[stone-monkey]

Can that really substitute as a placebo, though? I'd imagine you'd have to first verify that those teachings are no more effective than a placebo, which runs into the same problem as the original purpose of finding a proper placebo comparison.

Edit: Sorry, I misunderstood your comment. However, if they're testing the effectiveness of the meditation technique, then the teacher's belief in the method shouldn't affect the outcome of the result, assuming the technique is the same in both cases.

[chvid]

If you take an African witch doctor with hours of trance dancing and plenty of chicken blood, it is probably all placebo.

Both for someone of the same tribe, who has been brought up in the same belief system, having been taught to look at the doctors in awe, a dramatic treatment by a witch doctor probably is tremendously powerful.

My guess is that it will be much more powerful than mindfulness meditation. (And this is regardless of what is attempted treated - (self-reported) pain from a hot prick or the common cold.)

In others words; the self-healing/self-suggesting effects that we call placebo has something to do with belief; and probably belief in a broad sense, whether the subject believes, whether the doctor believes and whether the surroundings in general believes.

In a way things like mindfulness meditation is part of the "folk-religion" of the modern man. Read any women's magazine / self-help book and it will tell you that mindfulness, positive thinking, biodynamic food and exercise has strong effects on your physical, psychological, sociological, even financial well-being.

Most of this is not science. But some science supports of the claims.

I think that a good question for science to ask is "has these things always been true?" Are they deep physiological facts or are they changing over time, over culture?

The study summary mentions that the effect of the cream was 10%. The cream I suppose was made to look like traditional western medicine applied by some kind of nurse or doctor.

Suppose this experiment had been done in the 50es where skeptism towards Western medicine was much lower and a doctor's authority was much stronger. Would the effect be same? My guess is it would be stronger.

Likewise maybe saying a prayer worked better for the believing Christian Western man of 200 years ago than the modern "scientific" techniques of positive thinking, mindfulness etc. would have.

How would you crack this in a scientific experiment?

It is probably very hard because the experimenter's beliefs also comes into play. Double-blind is one way to go about this but for what is examined here it is probably not possible to do effectively. And secondly the subjects would be affected by what they believe works and already know about.

Maybe a simple place to start would be to ask the subject (and the experimentor) if they believe the treatment would work? And maybe survey general attitudes towards traditional medicine, alternative medicine, meditation, health etc.

[ZeroFries]

How far down the rabbit hole does it go though? Even if you show a physical mechanism, you can always claim it was your belief system and mental state which allowed the physical mechanism to take place. You're liable to end up in a cholera-esque place where people subconsciously or consciously create their own realities.

[chvid]

The rabbit hole is probably very deep.

But some of these things are well-understood. So if you test a pill and it is green, tiny, makes your tommy hurt for 10 minutes - then make sure that your placebo has the same properties in the your double blind experiment.

Secondly you can break things down and find out why they work. Why does mindfulness meditation stop the pain of being burnt?

Psychology as a science has many problems; in a way I think they believe too much - have too many strong ideas. I guess that is why the treatments have changed so much thru the years - and the diagnosises too - people have completely different (psychological) diseases today than a few decades ago.

Also their experiments are often underpowered or have methodological errors.

Maybe they should devote themselves to studying placebo rather than perceived actual treatments.

It would be useful to know if the pill should be red or green, the nurse brunette or blonde.

:-p